Office Ultrasound Has Advantages for Rheumatologists
NEW YORK – Using ultrasound to guide the diagnosis and treatment of rheumatologic conditions has been the standard of care in Europe for several years, and now the practice is becoming more common in the United States, according to Dr. Jonathan Samuels.
In 2008, Dr. Samuels and his colleagues at New York University surveyed members of the American College of Rheumatology and rheumatology fellow trainees across the country. They found that although about 20% said they were currently using ultrasound, more than 75% said it should be a standard clinical tool in the specialty (Bull. NYU Hosp. Jt. Dis. 2010;68:292-8). This suggests a trend that more rheumatologists are using ultrasound than a decade ago, said Dr. Samuels.
Ultrasound is also being introduced into many U.S. fellowship programs and academic departments for both clinical and research purposes, he said, adding that physicians have an increasing number of opportunities to train in the best ways to use ultrasound for rheumatologic conditions. The ACR has launched its own series of courses on using ultrasound. Rheumatologists can also get online education and guidance through the USSONAR (Ultrasound School of North American Rheumatologists). For the last 2 years, this institution has conducted an annual competency exam.
Meanwhile, the issue of certification remains up in the air. The ACR Musculoskeletal Ultrasound Task Force has been working to determine if and how it should certify its members in the use of ultrasound. ACR officials are currently surveying their members on this issue, said Dr. Samuels, a rheumatologist at New York University.
Dr. Samuels said that office-based ultrasound offers a number of advantages: it's painless and does not induce claustrophobia or anxiety. There's also no need for patients to be still for long period of time and no radiation exposure.
Ultrasound is much less expensive than other imaging alternatives.
Ultrasound also allows physicians to evaluate multiple joints from a number of views in a single imaging session, he said.
There are a number of potential uses for ultrasound in rheumatology, such as in diagnosing and evaluating treatment for inflammatory arthritis, crystal disease, and osteoarthritis (OA).
In inflammatory arthritis, ultrasound can help with diagnosis and prognosis by detecting erosions, synovitis, effusions, tenosynovitis, enthesopathy, and productive changes such as nodules and tophi. Rheumatologists can also evaluate treatment response by rescanning after prolonged treatment, he said.
In rheumatoid arthritis, clinicians can easily use ultrasound to look for erosions, Dr. Samuels said, and it is more sensitive than conventional radiography (Arthritis. Rheum. 2000;43:2762-70).
Ultrasound can also identify and determine whether it is necessary to aspirate a joint effusion in patients with knee OA. It can also help to guide injections that might otherwise be contraindicated if they were to be done blindly in the office, such as hip injections.
Dr. Samuels reported that he had no financial conflicts of interest.
Ultrasound (left) shows cartilage wear in knee oseoarthritis. An ultrasound of a metacarpophalangeal joint (right), which was expected to show synovial effusion/synovitis, instead revealed a subcutaneous cyst and a normal MCP.
Source Courtesy Dr. Jonathan Samuels
